Individual
GEOFFREY MARK FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256
(317) 621-5100
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01056568A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200505110
—
IN
Enumeration date
10/06/2006
Last updated
11/27/2023
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